My colleagues and I performed a systematic review of the international literature on central retinal artery occlusion (CRAO).

Although many potential therapies for CRAO have been proposed to date, none has been shown effective in a randomized, controlled manner. Various conservative treatments have been proposed for acute CRAO, but their efficacy remains unproven.

For more than 20 years, CRAO has also been treated with thrombolytic agents administered intravenously or intra-arterially, but the benefit of this treatment also remains uncertain. Thrombolytic studies are retrospective and uncontrolled. A prospective controlled clinical trial of intra-arterial thrombolysis is ongoing in Europe and should provide more reliable information.

Still, even if this trial demonstrates a benefit, thrombolytic treatment is unlikely to become widespread in the management of CRAO unless it can be deployed quickly after the event.